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Understanding tantrums

The five tantrum "red flags"

WebMD reports: All child tantrums are excruciating to parents. But there are five tantrum styles that are "red flags" indicating a preschooler may have mental health problems.

Washington University researchers in the US, Andy C. Belden, Ph.D., Joan L. Luby, MD, and colleagues, conducted long, structured interviews with 279 caregivers - nearly all of them mothers - of 3-to-6-year-old children. They also evaluated the children for psychiatric disorders.

They found that tantrums in children who truly had mental health problems tended to be different from tantrums in healthy children.

Belden warns that normal children may display every one of these tantrum warning flags from time to time. But kids with problems show these signs in nearly every tantrum:

Aggression toward caregivers, objects, or both

If this happened more than half the time in the last 10 to 20 tantrums, it may signal disruptive disorders. "It is not uncommon at all for children to try to kick their mums because they won't buy them an ice cream cone. But if this happens 90 percent of the time, and you have to take cover to protect yourself during a tantrum, this may mean a problem," Belden says.

Self-injury

Kids with major depression and kids with mixed major depression and disruptive behavior were much more likely than healthy kids to bite themselves, scratch themselves, bang their heads against a wall, or kick objects in an attempt to hurt their foot.

Frequent tantrums

Preschoolers who have 10 to 20 tantrums a month at home, or who have more than five tantrums a day on multiple days outside the home, are at risk of a serious psychiatric problem.

Very long tantrums

A five-minute tantrum can seem like a million years to a parent. But kids who consistently have tantrums that last more than 25 minutes may have underlying problems. "A normal child may have a tantrum that lasts an hour, but the next one lasts 30 seconds. These children with psychiatric disorders are having 25-minute or longer tantrums 90 percent of the time," Belden says.

Inability to calm oneself after a tantrum

"These kids almost every time require some sort of external force to calm them down," Belden says. "You have to constantly remove them from the situation or bribe them or it will go on and on."

What parents should do if their child has "red-flag" tantrums

"You can go two ways. One is to take the child to a pediatric neuropsychologist to get a broad assessment, including what is going on in the family, because some of this is absolutely in response to family difficulties," Belden says. "The other way is to go directly to a child psychologist who will focus on the child's emotional control and on the family circle."

If your child has tantrums, don't feel alone. Seven out of 10 18-to-24-month-old toddlers throw tantrums. And more than three-quarters of 3-to-5-year-olds have tantrums.

Belden and colleagues report their findings in the January 2008 issue of the US Journal of Pediatrics.